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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

‘It’s not only about the condition: it’s about the patient as a whole’

Sheila Johnston talks to Jessica Asante about her busy career caring for patients with chronic kidney disease and why her passion for nursing is ever-growing

Lead nurse and clinical lead in chronic kidney disease (CKD), Sheila Johnston laughs, “I am really lucky that I don’t get hugely stressed.” This comes as a surprise as Ms Johnston juggles being a renal nurse at Royal Free London Foundation Trust with working at five different sites, managing community hypertension, renal genetics and running other community clinics.

Ms Johnston saw her sister handle the pressures of nursing – she would come home and tell her anecdotes about her busy day. She was inspired to take on the role herself and experience what it would be like to have a positive impact on a patient’s condition. She wanted to work with a patient from initial diagnosis to planning palliative care.

Thirty three years later, Ms Johnston does more than simply affect a patient’s condition. “I began training in November 1982 and finished in 1984, after four years in older person’s rehabilitation I took a conversion course that took me back to the basics of nursing,” she says.

The nature of Ms Johnston’s experience allows her to act as a patient advocate. She provides counselling for patients from many backgrounds. “Being in a role that has a mixture of management, leadership and clinical work all improves my professional credibility,” Ms Johnston says. There is no doubt that Ms Johnston has a lot to manage, however, this is not left for her to do alone.

She holds her team to a high standard, “I am extremely proud of my team, it is a completely nurse-led service and we value the work that we do.” Nurse-led services are extremely common as the roles of nurses and doctors begin to blend.

Nurses across the nation are taking this in their stride, much like Ms Johnston and her team. “It is important that modern-day nurses rise up and meet challenges ensuring patients are at the centre of all they do.”

Ms Johnston’s passion for CKD is evident as she speaks about what she sees as most important: “I think it is so important to try to reverse the reversible; doing everything you can to slow down the rate of decline,” she says. “This involves health promotion, medication and palliative care where necessary.” Ms Johnston may not specialise in these areas but working in a multidisciplinary team allows her to constantly expand her skills.

For example, running a monthly joint clinic with specialist palliative nurses. Ms Johnston says, “This has been a huge learning opportunity for the whole team because it allows a mix of skills. The team’s confidence has risen as we have been more exposed to ways of improving.” Ms Johnston enjoys her job but also has her fair share of difficult situations.

“One situation that I experience frequently is patients not engaging early.” In the management of CKD, the earlier treatment is provided the better. She emphasises that it is difficult for patients to face the realities of CKD and the lifestyle changes that follow.

”Patients are complex people and rarely exist with one condition”

“One patient I worked with was too busy to be ill and therefore didn’t engage very well,” she says. “I needed to act in his best interest and I understood work meant a lot to him, so I tried to use that as an incentive. If he wanted to continue to prioritise work, he would have to first focus on his health.” Ms Johnston is constantly learning and engaging in different opportunities to improve her nursing care.

“If I could give any advice to students and newly qualified staff nurses, it would be to get as much experience as possible,” she says. “Patients are complex people and rarely exist with one condition so it is important to have a grounding of experience.” Ms Johnston recognises the pressures nurses face but stresses the importance of the basics of nursing. “Remember what you’re there for; remember what’s important to the patient.”

Ms Johnston continues to prioritise her patients: “Passion for the work I do is my main drive and I feel very lucky to have the authority to do this,” she says. “The journey to recovery can be hard for a patient. I am here to make it slightly easier for them.” NT

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